Thread by @Richard_Autism

Best get on creating this diagram showing showing my views on how diagnostic categories are constructed.

Finished drafting the diagram earlier.

Two images below, but with text & text boxes colours inverted for ease of access.
Both images show a model for describing how diagnostic categories like autism/ ADHD/ BPD are constructed similarly to gender.

Feedback welcome on diagrams.

It is relatively detailed, but hopefully, not too much to be easily understood. I have added developmental/ age related factors into a person's spiky features profile. I added a component for biological factors.

A person's spiky features profile is independent of the diagnostic categories.

I added a loop to represent looping effects, in how a people's biases shape diagnostic categories and the diagnostic categories in turn effect cultural values.

Below image might be better for others to access it, as in the diagram background should be filled in white.

I discuss that a clinician's bias is important in the diagnostic category a person is attributed with, or not here:
threadreaderapp.com/thread/1622647…

However, the bias of the person undergoing the assessment & anyone, like caregivers providing evidence as part of an assessment for a diagnostic category will also shape the diagnostic category.

Example, is during my autism assessment, I was asked if I had sensory issues. I said no. I said no, as I only had my own reference point to judge if my sensory experiences are issues, as I went into autism assessment process ignorant about autism.

"Most of the studies relied exclusively on parental report for inclusion criteria and identification of PDA. This heightens the risk of relationships between measures being confounded by common method, reporting, and confirmation bias (Green, 2020)...

"... Diagnostic studies in autism suggest that the validity of proxy reports varies according to informants’ expectations, competence, observational skills and relationship with the autistic person (Havdahl et al.,
2017; Helverschou & Martinsen, 2011)..."

"... and are not always in line with reports from the autistic individuals themselves (e.g. Kalvin et al., 2020)..."

"...Moreover, there is a possibility that parental reports may also have been affected by pre-existing ideas and understandings of PDA gleaned from the PDA web forums and conferences from which they were recruited."
@ArvidNK et a; 2021, p2171.

"One of the strengths of the current study was that the data used were collected in 2010 or earlier: for the most part prior to the large peak in interest in PDA and the series of annual conferences on the topic held in the UK..."

"As such, it is likely that clinicians were not particularly ‘on the lookout’ for PDA features in their cases."
O'Nions et al 2016a, p418.

Previous 2 quotes show that bias of clinicians & those contributing information for assessments of autism or PDA can affect the resultant diagnostic category reported; i.e., bias what diagnostic categories are attributed & what details are mentioned in the diagnostic categories.

Suppose substantial parties are aggressively pushing PDA as a "Profile of ASD" & that affects the bias of clinicians, caregivers & those undergoing assessment for PDA. Would the features described in PDA change to adopt "autism-like" aspects?

Well we can analyse different PDA behaviour profiles & to see how those descriptions have changed over time. Has anyone done this?
Someone of no major import (maybe a tad hyperbole) has done this in the below essay:
researchgate.net/publication/36…

Previous essay also points out that "PDA Profile of ASD" has gained substantial interest & there are example of some suspected autistic persons seem to have internalised "PDA Profile of ASD".

The looping effects which seem to be occurring explain how it is possible for non-autism features described in PDA can be easily confused for being autism features, if people are biased towards "PDA Profile of ASD".

To this into context a person's spiky features profile is independent of the diagnostic category. So features like rapid mood changes, anxiety, criminal behaviours etc; are real & exist...

... If the clinicians, caregivers, persons being assessed view PDA as a "Profile of ASD", is easy for people to confuse those non-autism features as autism features; PDA construct, will change to reflect autism-like understandings, like a dual ASD + PDA traits diagnosis.

First image = O'Nions 2013, p93
Second image = Soppitt 2021, p299
Third image = Woods 2021, p12.

Three images below model features of PDA being attributed to accepted constructs like anxiety, autism, ADHD.

What if PDA is not autism & the likes of PDA Society, Phil Christie, Judy Eaton, Ruth Fidler & other prominent "PDA Profile of ASD" are confusing themselves by assuming PDA is a form autism?

Seems one would predict what is presently happening with "PDA Profile of ASD"...

Let that one sink is prominent "PDA Profile of ASD" supporters are mistaken on PDA & are confusing non-autism features with autism; they would likely be ardent PDA is a "Profile of ASD", while not realising it.

Oh boy, that predicted bubble bursting is unlikely to be pretty!

@ElaineMcgreevy I think I have cracked PDA, to some extent.

Should say.
*Let that one sink if prominent "PDA Profile of ASD" supporters are mistaken on PDA & are confusing non-autism features with autism; they would likely be ardent PDA is a "Profile of ASD", while not realising they are mistaken.
...*

https://twitter.com/Richard_Autism/status/1623824712315830274

Gone a bit tangential there, but it shows you what can be done with the model on diagnostic categories are constructed.

I have updated the model to include a second loop from cultural values to affect the situations a person experiences.
First two images have text colour & text box colours inverted on transparent background.
Last image has a white background.

There is an arrow from aversive situations to trauma.
Reason

Motivation for change was reflecting upon implications on below study, indicating adverse affects diagnostic categories can have on others people's perception.
link.springer.com/article/10.100…

An example is report of Kent SEND schools refusing to provide education placements to those diagnosed with PDA.

Afterall, who would want to employ someone with a "pathological"/ "extreme" avoidance to "ordinary" (often other people's) demands?

I am aware of reports of PDA diagnoses affecting a CYP , by educational placements being denied, or ended early. This has adversely CYP in missed opportunities, aversive opportunities & trauma.

For some a diagnostic category may help people to receive positive experiences. Hence, why there is an arrow to positive experiences.

This is my point about, why giving someone a diagnostic category should be viewed as a long term intervention, with same standards. Attributing someone with a diagnostic categories often has a profound impact on a person's life, sometimes good-sometimes bad.

It matters for many diagnoses, which represent pathologising of distress. For example if a CYP experiences many aversive situations & trauma due to how people treat them due to having a PDA diagnosis; CYP should present MORE PDA features.

First image is demand management cycle.
Last 2 images are a developmental model for developing & maintaining PDA features.

It makes, the stressed & distressed a person, more likely they are to express features like:
Rapid mood changes
Using roleplay/ pretend as a coping mechanism, express social avoidance behaviours etc etc.

I accept for many persons, being attributed a diagnostic category can sometimes lead to them receiving beneficial approaches/ "treatments", which lead to them having positive experiences etc. This obviously has an affect on a person's spiky features profile.

On that note I will repost the latest version of the diagram below:

End of thread.

@threadreaderapp please can you unroll?

Thank you in advance.